支气管扩张急性加重期的治疗现状及初治失败相关因素的Logistic回归分析

Logistic regression analysis of initial treatment failure related factors of acute exacerbation of bronchiectasis patients

目的探讨支气管扩张急性加重期患者的治疗现状,并分析影响初治失败的主要因素。方法采集病房2018年1月至12月间174例支气管扩张急性加重期(支扩)患者的病历资料,根据病情、用药等情况进行初治疗效判定,分为初治失败组(无效组)和初治有效组(有效组),观察包括性别、年龄、合并病、吸烟史/烟雾暴露史、BMI、mMRC、BSI、症状、营养等20项指标,并对初治失败的相关影响因素进行单因素及其Logistic回归分析。结果174例支扩患者初治失败49例(28.16%),经统计,影响疗效的单因素有6项:过去1年急性加重次数、mMRC、BSI、神疲并/或乏力症状、血清白蛋白计量,以及血清血红蛋白计量(均P<0.05)。进一步logistic回归分析,主要的影响因素是神疲乏力症状(OR=2.713,95%CI:1.3156~5.5931)和血清血红蛋白水平(OR=2.262,95%CI:1.0786~4.7434)(均P<0.05)。结论支扩急性加重期初治失败的相关因素较多,我们运用BSI工具评估的同时,要关注患者近期发病的情况、营养状况及活动能力的评估,尤其精神体力状态和贫血相关因素的判断,加强监护及营养支持,减少初治失败。

Objective To observe the clinical effect of acute exacerbation of bronchiectasis patients,and to analyze the main factors leading to the initial treatment failure.Methods 174 inpatient bronchiectasis cases from January to December 2018 were divided into two groups:the initial treatment failure group and the control group.20 factors including sex,age,comorbidity,smoking/smoke exposure history,BMI,mMRC,BSI,symptoms,nutritional status,were analyzed individually,and in the multivariate logistic regression model.Results 49 cases(28.16%)were initial treated failure.After analysis,it showed us 6 factors were relative to the initial treatment failure,including the times of acute exacerbation,mMRC,BSI,fatigue/hypodynamia,serum albumin count,and serum hemoglobin count(all P<0.05).Through logistic regression analysis,the 2 factors were the main relative ones:fatigue/hypodynamia(OR=2.713,95%CI:1.3156~5.5931)(P<0.05)and serum hemoglobin count(OR=2.262,95%CI:1.0786~4.7434)(P<0.05).Conclusion The factors leading to initial treatment failure of bronchiectasis in acute exacerbation is complex.We should use the BSI tool in the clinical evaluation of bronchiectasis,focus on the acute exacerbation,nutritional and the physical activity situation,especially the fatigue/hypodynamia and anemia relative factors,and upgrade the nursing level and nutritional support therapies,so as to reduce the chance of initial treatment failure.